Read news about the Bill and Melinda Gates Foundation, Greenwall Foundation, and Foundation for a Healthy Kentucky. See descriptions of two policy jobs at health foundations. These tidbits recently came across my desk.

So, if you were planning to submit some other kind of proposal to the foundation, make sure to read the application guidelines. Applications will no longer be accepted, for example, for the Greenwall Fellowship Program in Bioethics and Health Policy.

The foundation has a new president, too–watch for that announcement in the GrantWatch section of the February 2012 issue of Health Affairs, which will be released online February 6.

Investing in Kentucky’s Future, the funder’s other priority, has to do with improving the health of children in the Bluegrass State by “promoting the development and expansion of comprehensive community-based initiatives, including school-based programs.”

Details are forthcoming on the two priorities.

Please note that this foundation does not accept unsolicited requests for grants, except for requests for matching funds and for funding conferences, seminars, and symposia that are related to the foundation’s mission and priorities and are conducted by nonprofits. Watch for its requests for proposals (RFPs) and requests for quotes.

Gates Foundation Is Focus of Hudson Institute Panel

The Hudson Institute’s Bradley Center for Philanthropy and Civic Renewal, along with Alliance magazine, co-hosted a panel discussion in Washington, D.C., on December 6, titled “Living with the Gates Foundation.” Moderated by Bill Schambra of the Hudson Institute and Tim Ogden of Philanthropy Action, the panel included Ogden, a guest editor of the September 2011 Alliance magazine issue focusing on the Gates Foundation; Laura Freschi of New York University’s Development Research Institute; Darin McKeever of the Bill and Melinda Gates Foundation; and Ed Skloot of Duke University. I listened to the two-hour webcast and found it fascinating—plenty of thoughtful comments. Here are just a few highlights.

Schambra opened the discussion by saying that the Gates Foundation “dominates the landscape of American philanthropy in a way that no single foundation has done since probably the earliest days of the Rockefeller Foundation at the turn of the twentieth century.”

NYU’s Freschi said that the Gates Foundation is more nimble, focused, and willing to take big risks and invest in research and development than other more traditional, international aid programs. Funding research and data collection will benefit the whole field, she noted. However, she raised questions about the foundation’s accountability, its bias for technological solutions, and its advocacy work. For example, she challenged the foundation to provide details of more failures it has encountered in its work and to do some “honest self-evaluation.” Perhaps those could be mentioned on its website, Freschi said.

Skloot senses that the philanthropy sector is concerned about the Gates Foundation. On the other hand, it may be the model that philanthropy has been seeking. Skloot listed the foundation’s seven strengths, in his view. For example, it has a huge amount of assets and funds in a focused and thematic way. Also, it is a “relentless advocate,” unlike other funders that pay grantees to do advocacy, he said. “Its political ear is always very close to the ground, both nationally and globally,” even locally when needed, Skloot said. He mentioned that Gates has 50–75 people working in Washington, D.C.

Skloot discussed the foundation’s use of media. He said that Bill Gates’s Annual Letter is instructive and informative, and the foundation has an active website. The founders of the foundation are “ubiquitous and savvy” and are publicly associated with the foundation’s work.

People may criticize the Gates Foundation for it, but Skloot noted that it collaborates at the highest levels—with international nongovernmental organizations (NGOs) and with corporations. For example, the Gates Foundation has succeeded in “moving the marketplace,” Skloot said, so that certain vaccines become available at the right price and the right place for the poor.

However, he has concerns about the foundation in three areas: accountability, transparency, and collaboration and communication. On the third point, he mentioned that a Center for Effective Philanthropy survey has shown that the Gates Foundation is poorly understood by its grantees and partners. And the foundation has acknowledged that.

I surmised from the discussion that what makes some people look at the foundation carefully is the amount of money involved in its grant making and the power that may bring.

Darin McKeever of the Gates Foundation, who was a good sport throughout the discussion about his employer, commented that in his personal view, scrutiny and critical dialogue about even a good deed is useful because it can make “the next good deed better.” He also emphasized to the audience the personal belief of Bill and Melinda Gates that all lives have equal value, no matter where they are lived. McKeever explained that staffers at the foundation are not blind to the fact that it is big! He also said that it is putting much energy into building strong relationships with its grantees and other partners. It also is trying to stimulate “fresh thinking, critical feedback, and spirited dialogue.”

During the Q & A, McKeever said that he liked Skloot’s comment (before the event) that “sometimes ‘no’ is better than the indefinite ‘maybe’ when it comes to negotiating grants” with those applying for funding.

For more information, read the twenty-seven page Hudson Institute transcript on the event here.

Related resources:

Read the 2012 Annual Letter from Bill Gates on the foundation’s work during the past year. The content on polio; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and the foundation’s new headquarters in Seattle caught my eye.

Read correspondent Bill Weir’s blog post about his interview with Bill Gates, which aired on ABC Nightline on January 24. Some 75 percent of the Gates Foundation’s money is spent on the poorest countries in the world, the post notes. In this wide-ranging interview with Yahoo! and ABC News, “Gates scoffs at the idea that the money would be better spent at home,” Weir reports.

Two Health Policy Job Openings at Foundations

The Foundation for a Healthy Kentucky, located in Louisville, is looking to hire a health policy officer. The person hired will have lead responsibility for its new policy initiative mentioned above. Experience with Kentucky state government is preferred. Read about the other qualifications needed, position description, and salary range, and apply here.

The president of the Blue Cross Blue Shield Foundation of Massachusetts hits some of the highlights of a recent foundation-supported report on that state’s ongoing health reform effort.

Call it what you like—“RomneyCare,” “ObamneyCare,” or plain old Massachusetts Health Reform—it’s working pretty much as intended, at a cost that’s within what was projected, and with continued broad support from the general public and the state’s health care stakeholders. These are among the findings in a five-year progress report recently published by the Blue Cross Blue Shield of Massachusetts Foundation.

The report is the latest in a decade-long series of foundation-sponsored research studies, policy papers, and opinion surveys that helped inform the design and implementation of the 2006 Massachusetts reform law and have since assessed its impact. An assessment of the latest findings from one of those ongoing studies, the Massachusetts Health Reform Survey, can be found in a Health Affairs Web First published this week (free access to full text for two weeks).

However strongly some may disagree with the way Massachusetts health reform was accomplished, or even with its underlying goals, it’s hard to argue with the results. An estimated 98 percent of the state’s 6.5 million residents had health insurance in 2010, by far the highest rate of people with health insurance in the nation. As more residents have gained coverage, fewer have reported they have unmet needs for care, especially middle- and low-income residents, members of racial and ethnic minorities, and people with chronic diseases. For those of us who are committed to expanding access to health care, particularly for low-income and disadvantaged individuals and families, this is cause for celebration.

Focusing on goals and results

The foundation’s report examines what each of the major provisions in the 2006 law was intended to accomplish and how it is working. Prior to health reform, nearly three-quarters of the state’s uninsured were low-income individuals who couldn’t afford to purchase health insurance, but whose earnings were too high to qualify for Medicaid. Many were part-time workers or employees of very small businesses where employer-sponsored coverage was not offered.

Setting a goal of nearly universal coverage, the law includes a mix of programs, incentives, and requirements that make coverage more affordable for low-income residents while also encouraging employer-sponsored and individual enrollment in private health plans.

Lawmakers used the flexibility allowed by the state’s federal Medicaid waiver to expand subsidized coverage to low-income residents through a new program called Commonwealth Care and to restore and expand some categories of Medicaid coverage, with federal and state funding split roughly 50/50. Reflecting the Massachusetts law’s underlying principle of shared responsibility, it also famously includes an individual mandate–the requirement that residents obtain health coverage if an affordable plan is available to them or face a financial penalty–and it makes employers with eleven or more workers financially accountable for failing to make a “fair and reasonable” contribution to their employees’ health coverage.

To make it easier for individuals and small businesses to find and purchase affordable coverage, the law created an insurance exchange, the Massachusetts Health Connector. The Connector was given a dual role–to oversee subsidized Commonwealth Care coverage for low-income residents and to act as an online, one-stop shopping site for selected, unsubsidized individual and small-business plans that can also be purchased directly from the private health plans themselves.

Along with the overall gains in coverage and access to care, the progress report points out that employer participation in offering health insurance has risen under health reform. Seventy-seven percent of Massachusetts employers with three or more employees offered health insurance coverage to their employees in 2010, up seven percentage points since 2005. (This compares with 69 percent of all employers nationwide that offered health coverage to their workers in 2010, according to the [Henry J.] Kaiser Family Foundation/Health Research and Educational Trust 2010 Annual Survey.) The Blue Cross Blue Shield of Massachusetts Foundation progress report finds that the Connector’s active procurement process has helped keep increases in the cost of subsidized plans for individuals well below the market average, but it has so far been unable to make a sizeable dent in the small business market.

As for the overall cost of health reform, the state’s share amounted to just over one percent of its $32 billion overall budget last fiscal year, and the average incremental cost of expanded public coverage has been well within early projections.

The challenge of rising costs

The 2006 law was not designed to tackle the state’s historically high health care costs. It did, however, help trigger a process of examining the underlying causes of high costs and developing recommendations for changes in care delivery and payments to providers. The past two years have been marked both by increased pressure from state regulators and by private-sector initiatives such as the widening adoption of global payment as the basis for contracts between health plans and physician groups and some hospital systems. While several major cost-containment proposals have been filed with the Massachusetts legislature, including one from Governor Deval Patrick (D), no consensus has emerged so far on what, if any, role the state should play in holding down provider payments and health insurance premiums.

In 2011, out of concern that relentless increases in health care costs could threaten the state’s ability to deliver on its commitment to make coverage accessible, the foundation decided to focus more resources on finding ways to make health care delivery less costly without sacrificing access or quality. We created a new grant-making program area focused on supporting sustainable cost containment initiatives, and we’re sponsoring extensive research on health care costs and potential solutions. Our goal is to act as a catalyst for the state’s health care community to address costs with the same level of commitment, innovation, and unified action that we saw during the first round of Massachusetts health reform.

As the progress report concludes, “If Massachusetts is able to moderate future increases in health care spending while continuing to expand access to coverage and care, its status as a pioneer in transforming the U.S. health care system will be assured.”

Since the founding of the Blue Cross Blue Shield of Massachusetts Foundation in 2001 as an independent, not-for-profit organization, the foundation has sponsored research, convened stakeholders, and made more than $38 million in grants to community health centers, hospitals, and consumer groups to support outreach, enrollment, care coordination, and advocacy on behalf of uninsured and under-insured, low-income residents of Massachusetts.

Read about the New York State Health Foundation’s “five-year, $35 million campaign to reverse the diabetes epidemic [in the Empire State] by improving clinical care, sustaining a comprehensive and coordinated care system, and promoting prevention.”

The GrantWatch Profile in the January 2012 issue of Health Affairs, titled “New York State Health Foundation’s Diabetes Campaign Is Influencing Practices to Improve Care,” by freelance writer Harris Meyer, describes the campaign. The “extract” is free access to all.

How did the foundation decide to fund this campaign? Foundation staffer Jacqueline Martinez Garcel says in the article that the New York State Health Foundation (NYSHealth) learned, shortly after this statewide funder was up and running (it was established in 2006), that “diabetes was the only chronic condition in the state that was increasing.” According to the article, annual costs of this chronic condition were also growing rapidly in the state. And, additionally, quality of care for diabetics could use some improvement—many of those with diabetes were not getting all of their recommended screening tests and exams.

The campaign focuses on people with adult type 2 diabetes and their interactions with primary care providers. On the practitioner side, the foundation has been encouraging primary care practices (specifically, federally qualified community health centers, outpatient departments of hospitals, and solo providers in New York State) to adopt the Chronic Care Model, developed by Ed Wagner and his colleagues. The article calls this model “the forerunner of the patient-centered medical home.”

Author Harris Meyer includes examples of work by each kind of grantee—sole practitioner, hospital system, and community health center.

He also mentions a new phase of the foundation’s diabetes campaign called Meeting the Mark, which invites insurers, group primary care practices, and other stakeholders to help physicians to obtain recognition by the NCQA or Bridges to Excellence.

Results of the campaign to date are promising, Meyer reports, although it is still too early to determine if the foundation’s efforts to transform diabetes care statewide have reduced avoidable hospitalizations or emergency department use for diabetics. Formal evaluations of the campaign will be conducted.

The foundation’s “improving diabetes prevention and management” priority area includes the campaign and more, such as an online resource center.

The January 2012 Health Affairs is a thematic issue on “Confronting the Growing Diabetes Crisis.” The United Health Foundation, Novo Nordisk, and NYSHealth funded this issue. Read the Table of Contents here. Abstracts of the articles are free.

The author, a high-ranking official in Colorado’s health department and a family physician in his previous work life, is president and CEO of the Colorado Trust. This statewide health foundation is based in Denver. GrantWatch Blog invited Ned Calonge to reflect on his experiences in the foundation and state government sectors.

It’s been a little over a year since I left the Colorado Department of Public Health and Environment, where I was the medical director, to accept the position of president and CEO of the Colorado Trust. While it’s clear I still have a great deal to learn about philanthropy and the foundation and nonprofit sector, it has been interesting to me to reflect on the similarities and differences of the two approaches to addressing the health of our communities.

One of the welcome differences is being free to be circumspect in sharing observations, opinions, and even data. Unfortunately, in my view, even the best, most transparent government officials feel the need to control or “spin” information, though it’s true that some are worse than others. Public image, politics, advocacy, and special interests all play key roles in what government employees are allowed to say, how and what information is released, and how findings are emphasized and acted on.

Foundations, on the other hand, have the ability to undertake studies and evaluations, produce reports, release information, and promote information use much more freely. Our commitment and our accountability are to our missions, to the truth, and to the best interests of the communities we serve. Of course, our reports must be valid, balanced, and respectful of the differing views and ideologies of others, but we can collect, analyze, and disseminate actionable information and make recommendations without having to worry about image, politics, and what special interests might think.

Another freedom relates to the core work of foundations, that of making grants and supporting projects that may lie outside the political arena. One state health official I know used to say, “there is plenty of money in state government, it’s just distributed poorly.” With the current economy and in light of Colorado’s harsh tax-limitation laws, I might disagree with the adequacy of the amount of state funding, but there is truth in the statement. At least one measure of success for a state legislator is getting funding for his or her own bill, project, or program. This legislative decision making, with accountability to different constituencies, is one cornerstone of our democratic process. In my experience, however, it often can result in low-value investments and the distribution and use of state tax dollars not being well-aligned with the most critical needs and issues of the communities served.

A high-functioning foundation, on the other hand, may work directly with the communities it serves and can design funding strategies that are best suited to local needs. I find this difference the most rewarding part of philanthropy.

On the other hand, in a private foundation, my ability to directly influence specific health policies is limited. Working in state government provides a leader with the ability to propose, craft, support, and ultimately implement new policies that have direct and lasting effects on the health of our state’s residents.

While this process is not simple or easy and requires the hard work and commitment of many different people—not the least of whom are the legislators who create state policy—state employees are much more hands-on in terms of creating and changing laws, rules, and regulations. While this process is under the authority and direction of the governor’s administration, the opportunity to directly affect policy can be very rewarding.

Finally, I have been pleased to realize that both sectors place a high value on using evidence to guide their work. The desire to be data-driven and evidence-based has long been a personal core value, and while evidence is only one factor considered in policy making (and is often discounted if it does not support the particular agenda of a given legislator), it is at least considered. Finding that health foundation leaders place great value on using evidence in crafting grant strategies has been a welcome, though not unexpected, learning this past year.

The bonus, however, is that alongside evidence-based strategies, foundations also have the ability to fund innovation. State governments typically do not risk the potential ineffectiveness of innovative, not-yet-proven strategies. Nor would government be inclined to acknowledge and disseminate information about what doesn’t work. That foundations are not only willing to fund innovation, but also are willing to report the results—whether effective or not—indicates an important commitment to using and generating evidence in our work and supports an agenda and a process that requires ongoing evaluation, reflection, and strategic learning as essential elements.

The ultimate goal of legislators and foundations in terms of health policy is a shared one: to make things better. For a former bureaucrat, the approaches, abilities, and tools differ in the foundation world, but the opportunity for these two sectors to work together toward this common goal in ways that make the sum more than the individual parts is a welcome aspect of my new position and one I look forward to continuing to embrace.

We compiled a list of the most-read posts during 2011, in case you missed any of these.

The most-read GrantWatch Blog post in 2011 was on the Robert Wood Johnson Foundation’s skill at using social media to communicate with those who follow its activities. And that is not surprising, because of the large population that follows what the “nation’s largest philanthropy devoted solely to the public’s health” is doing. We learned that foundations’ use of social media is a hot topic! This popular blog post, which came in “over-the-transom,” was written by Hope Leman, who is an observer of foundations’ and others’ use of social media, through her work for Samaritan Health Services, in Oregon.

Posts on a meeting held by foundations in the Southeastern United States about the PACE (Program for All-Inclusive Care for the Elderly) program; foundations’ funding of mental health care projects; and other topics also appear on this most-read list.

The full list, with links, appears below.

1. “The Robert Wood Johnson Foundation and Its Mastery of Social Media,” by Hope Leman, January 25, 2011. Leman works in Corvallis, Oregon, where she is Web administrator of the free, online, grants and scholarships listing service called ScanGrants, as well as the free, online listing of calls for papers and research-oriented meetings, called ResearchRaven. The sites are affiliated with Samaritan Health Services.

4. “Rural Health: Report from the Kentucky Health Policy Forum,” by Susan Zepeda (president and chief executive officer) and Amy Watts (now, senior program officer for the Primary Care Initiative) of the Foundation for a Healthy Kentucky, September 23, 2011. Read about this funder’s September 2011 policy forum. Speakers included Len Nichols of George Mason University, as well as Janie Miller, secretary of the Kentucky Cabinet for Health and Family Services.

On December 14, the Centers for Disease Control and Prevention (CDC) released findings from the 2010 National Intimate Partner and Sexual Violence Survey. The results may surprise you. For example, over the course of her lifetime, one in four women has been a victim of severe physical violence by an intimate partner. Here is a sampling of some foundations’ efforts to prevent violence of various types.

Sexual violence (rape), stalking, and intimate partner violence “take the largest toll on women, who are more likely to report immediate impacts and long-term health problems caused by their victimization,” the CDC’s Linda C. Degutis said in a press release. (Women are more likely than men to report the effects, the CDC clarified in an e-mail.) The survey findings emphasize that violence is “a major public health burden,” said the CDC.

And, of course, men are also affected: Approximately one in seven men, during his lifetime, has been victimized by severe physical violence by an intimate partner, the survey found.

Foundation Funding for Domestic Violence Prevention

Also on December 14, the Blue Shield of California Foundation’s Blue Shield Against Violence program awarded more than $2 million in grants. These fourteen grants were for strengthening culturally appropriate domestic violence services for Black and African American, Native American/American Indian, and recent immigrant populations across the Golden State. “Our research shows that many of California’s ethnic groups experience higher rates of domestic violence but may be less aware of and less likely to seek services,” according to the foundation’s president, Peter Long, in a press release.

Read about the “advancing the policy dialogue” facet of the foundation’s domestic violence prevention program. Please note that the Blue Shield Foundation is not accepting unsolicited requests for funding for this policy work.

Foundation Funding for Youth and Young Adult Violence Prevention

* Violence prevention is one of the eight health issues funded by the California Wellness Foundation under its Responsive Grantmaking Program. For example, it recently awarded $200,000 in core operating support to Commonweal for sustaining production and dissemination of reports on California’s spending on violence prevention.

According to the foundation’s Fall/Winter 2011 Grantee magazine, in an article titled “Violence Prevention: A Long-Term Commitment to Keep Youth Safe,” author Frank O. Sotomayor reports that, between 2002, when the foundation’s landmark Violence Prevention Initiative concluded, to the time he wrote the article, Wellness awarded some $58 million in violence prevention funding, making it California’s largest private funder of such programs.

Back in 1992, Wellness “embarked upon a long-term, multifaceted campaign to curb violent deaths and injuries for young people ages 12 through 24,” says the article. It notes that Wellness “became the nation’s first major philanthropic organization to embrace a public health model for violence prevention” and also worked with other foundations (the Alliance Healthcare, Crail Johnson, James Irvine, David and Lucile Packard, San Francisco, S.H. Cowell, and Sierra Health Foundations; and the California Endowment) which collectively pledged an additional $10 million for grants to prevent youth violence.

The article also discusses the Wellness Foundation’s role in changing the public policy conversation around youth violence; the work of its recently retired president and chief executive officer (CEO) Gary Yates and his predecessor, Howard Kahn; milestones during the initiative; and its grant making today in this field.

* The Robert Wood Johnson Foundation (RWJF) has been a long-time funder of CeaseFire. In early 2011 it awarded its most recent grant (for $4.5 million) to the organization, which is based at the University of Illinois at Chicago School of Public Health. CeaseFire, which started in 2000, “reaches out to teens and young adults to offer them direct alternatives to shooting and killing,” according to a page on the RWJF website, dated July 29, 2011. The newest grant is for expanding the initiative beyond Chicago.

“In Chicago, murders in CeaseFire zones dropped sharply over the decade,” the foundation reported. CeaseFire has national partners working in other cities such as New Orleans; Kansas City, Missouri; and Crown Heights, New York.

The RWJF and government entities support CeaseFire sites around the country. The Chicago Community Trust, John D. and Catherine T. MacArthur Foundation, Robert R. McCormick Foundation, Michael Reese Health Trust, Polk Brothers Foundation, state of Illinois, and others have supported CeaseFire Chicago.

* Another program to check out is Start Strong: Building Healthy Teen Relationships, which “is the largest initiative ever funded to target 11- to 14-year-olds and rally entire communities to promote healthy relationships as the way to prevent teen dating violence and abuse.” This RWJF national program funds ten sites around the United States; the Blue Shield of California Foundation funds one site in that state. Futures without Violence (formerly the Family Violence Prevention Fund) houses Start Strong’s national program office.

Related resources:

The Firearms Research Digest, a database launched by the Harvard School of Public Health, contains summaries of articles gathered from social science, criminology, medical, public health, and public policy journals, according to Harvard. The digest is meant to be clear and accessible to people outside academia, such as news reporters, policy makers, public health officials, and those in law enforcement who seek research and data on gun violence, said a press release. The website now covers the years 2000 to 2009, but Harvard updates it periodically. A current Joyce Foundation grant to the Harvard Injury Control Research Center includes funding for expansion of this online library. A previous grant helped to launch the digest.

Read about the National Violent Death Reporting System, a state-based surveillance program that makes available information on violent deaths from a variety of sources, including hospitals, medical examiners and coroners, and public health officials, says the website of the National Violence Prevention Network (a coalition advocating for nationwide implementation of the program). The information helps public health officials and organizations to better target prevention resources and programs, according to Paul Bonta of the American College of Preventive Medicine. In 2011 the Joyce Foundation awarded a one-year grant to that professional society; the funding is for education and advocacy efforts at the federal level aimed at expanding the reporting system to all fifty states and to U.S. territories. Eighteen states now participate. The grantee advocates for increased funding to the CDC for additional states to participate in the reporting system.